Nama : MAYASARI LINGGA

Kelas : 2.1 PSIK

NIM : 150206072

Case
A 70-year-old female presented with acute onset of severegeneralized abdominal pain. On
initial examination, she was pale and hemodynamically unstable with a heart rate of 120
beats per minute and blood pressure of 90/60 mmHg. Her significa past medical history
included an admission toanother hospital with history of melena 18 months previously. At
that time, colonoscopy and gastroscopy were normal but abdominal CT scan revealed a
suspicious lesion in theterminal ileum. The patient was scheduled for a small bowelcapsule
study as an outpatient but she was lost to follow-up.

On examination, her abdomen was peritonitic with anassociated palpable mass in the
hypogastric area. Her full blood count revealed a WBC count of 14,000 cells/ μ L and
a hemoglobin value of 8.5 g/dl. Serum urea and creatinine wereelevated at 120 and 2.1 mg/dl,
respectively, while the rest laboratory tests were within normal limits. After initial resus-
citationwith3 L ofintravenous crystalloids,anabdominal CT with oral contrast (intravenous
contrast was contradicted dueto the impaired kidney function) was carried out. The CT
revealed a large pelvic heterogeneous solid mass withirregular shape which extended from
the pelvis up to themidpoint between the umbilicus and the xiphoid process.

An emergency laparotomy was carried out revealing a large ruptured solid mass with cystic
componentsderived from the small bowel at about 15 cm from the ileo-ceacalvalve. There
was a notable amount offresh andclotted blood (about 2 L) in the intraperitoneal space.
Theinvolved segment of small bowel was resected and primarysmall bowel anastomosis was
performed.The histology examination reported a 20×18×5-cm gas-trointestinal stromal tumor
with necrotic areas and threemitoses per 50 high-power fields, suggesting a high-risk tumor.
Immunohistochemical studies of the tumor were positive for CD117 (c-kit) and CD34
and negative for S-100 and desmin. Margins of resection were cleared and
associatedmesenteric lymph nodes were negative of tumor cells
 PENGKAJIAN

INSPEKSI :
On initial examination she was pale
AUSKULTASI : -
PERKUSI : -
PALPASI :
- hemodynamically unstable with a heart rate of 120 beats per minute and blood
pressure of 90/60 mmHg
- On examination, her abdomen was peritonitic with anassociated palpable mass in the
hypogastric area.
\Seorang wanita 70 tahun disajikan dengan onset akut nyeri perut severegeneralized. Pada
pemeriksaan awal, ia pucat dan hemodinamik tidak stabil dengan denyut jantung dari 120
denyut per menit dan tekanan darah 90/60 mmHg. significa nya riwayat medis masa lalu
termasuk pengakuan toanother rumah sakit dengan riwayat melena 18 bulan previously.At
waktu, kolonoskopi dan gastroskopi normal tetapi perut CT scan mengungkapkan lesi yang
mencurigakan di ileum The Terminal. Pasien dijadwalkan untuk studi bowelcapsule kecil
sebagai pasien rawat jalan tapi dia mangkir up.On pemeriksaan, perutnya adalah peritonitic
dengan anassociated teraba massa di daerah hipogastrik. hitung darah lengkap nya
mengungkapkan jumlah WBC dari 14.000 sel / μ L dan nilai hemoglobin 8,5 g / dl. urea
serum dan kreatinin wereelevated pada 120 dan 2,1 mg / dl, masing-masing, sedangkan tes
laboratorium sisanya berada dalam batas normal. Setelah awal Resus-citationwith3 L
kristaloid ofintravenous, anabdominal kontras oral CTwith (kontras intravena dibantah dueto
fungsi ginjal terganggu) dilakukan. The CT revealed panggul heterogen massa yang padat
besar withirregular bentuk yang diperpanjang dari panggul hingga themidpoint antara
umbilikus dan xiphoid process.There juga koleksi cairan di keempat perut quad-rants (Gbr.
1). Sebuah laparotomi darurat dilakukan mengungkapkan massa yang solid pecah besar
dengan cystic componentsderived dari usus kecil di sekitar 15 cm dari ileo-ceacalvalve (Gbr.
2). Therewas jumlah terkemuka offresh andclotted darah (sekitar 2 L) di ruang
intraperitoneal. segmen Theinvolved usus kecil direseksi dan primarysmall usus anastomosis
adalah performed.The pemeriksaan histologi melaporkan 20 × 18 × 5 cm gas-trointestinal
stroma tumor dengan daerah nekrotik dan threemitoses per 50 bidang daya tinggi,
menunjukkan tumor berisiko tinggi [ 1]. Studi imunohistokimia tumor positif untuk CD117
(c-kit) dan CD34 dan negatif untuk desmin S-100and. Margin reseksi dibersihkan dan
kelenjar getah bening associatedmesenteric negatif dari sel-sel tumor